Is it time for “digital readiness” to become a unique SDOH?

Health systems around the world have poured untold billions of dollars into building digital front doors that aim to be welcoming and accessible to patients. But even after more than a decade of non-stop development, providers are finding that consumers are still struggling to find their way through.

Even in 2026, researchers are finding that digital access simply does not equate to digital accessibility, and some higher-risk populations are still being left behind as the care environment moves increasingly online.

For example, a massive longitudinal analysis of nearly 9.5 million people in Catalonia, a region in northeastern Spain, recently found stark disparities in who’s engaging with the nation’s MyHealth digital platform, despite the tool being available to all residents since 2015.

Spanish nationals and people living in higher-income areas were more likely to adopt and use MyHealth, while older adults, migrants, and rural residents used the platform less frequently.  

The differences persisted even through the COVID epidemic, when healthcare access necessarily became increasingly digital – and the fact that the tool was already well established by that time adds even more evidence that other systemic factors might be in play.

As healthcare continues to transform into a digitally native industry (especially as AI takes hold among patients and providers), the study raises an important and persistent question: how can health systems identify individuals who might struggle with digital accessibility and provide the right resources to help them engage more fully with their care?

The answer may come from treating “digital readiness” as a unique social determinant of health (SDOH) that overlaps with, but is still distinct from, existing markers of socioeconomic vulnerability.  

Why consider digital readiness as its own SDOH?

Conventional methods of identifying social determinants of health tend to describe the conditions surrounding a person: the ability to access transportation, food, or care resources, for example. These conditions may constrain a person’s opportunities and choices when it comes to living a healthier, higher quality life.

But circumstances are one thing. The capacity to work around or overcome them is quite another.

For one patient, the lack of broadband access at home may prevent them from engaging in certain healthcare activities. But another patient in that same community, experiencing similar external constraints, may have the additional capacity to gain internet access by another method.  They could be more familiar with smartphones, or have the time and transportation to use a computer at a library. 

That’s the gap that digital readiness is intended to measure, according to a research team from the University of North Carolina at Chapel Hill. And it’s something that existing SDOH indices may not be fully equipped to identify.

The team developed a specific Digital Health Index (DHI) using 21 measures across more than 85,000 US census tracts, incorporating socioeconomic conditions, healthcare access, and digital connectivity. When they compared their DHI with three other frameworks for identifying community vulnerability, they found that the measurement tools did not consistently identify the same communities as being among the highest-risk populations.

Among census tracts that the new DHI classified as having the lowest digital readiness, only 33% to 44% were also classified as highly vulnerable by the existing indices.

This suggests that more than half of the communities with the poorest digital readiness would not have been identified as among the most at-risk using those other measures alone – and that looking at communities through a more focused lens of digital readiness could capture barriers that are not adequately highlighted by other methods.

Developing digital readiness into an actionable measure for health equity

If conventional SDOH screenings cannot adequately capture the specifics of digital readiness, health systems and policymakers will need to explore different methods of assessing high-risk populations and integrating the results into the care process.

One option could be more tailored questionnaires that assess the multi-dimensional nature of digital readiness, according to an international team that fielded such a survey in the cardiology department of Jessa Hospital Hasselt in Belgium.

Their Digital Health Readiness Questionnaire (DHRQ) uses five domains to assess a person’s digital readiness status: digital usage, digital skills, digital literacy, digital health literacy, and digital learnability. 

“Digital learnability” measures the willingness and motivation of participants to improve their existing digital skills, the team explained.

The researchers found somewhat expected patterns in digital readiness when validating the survey internally. People with smartphones and smartwatches, higher levels of education, and younger age tended to score higher than older, less educated, and less connected individuals.

“The DHRQ has the potential to be implemented as a useful tool to gain insight into the patients who are treated in a care pathway, tailor digital care pathways to different patient populations, and offer those with low digital readiness but high learnability appropriate education programs in order to let them take part in the digital pathways,” they wrote.

The last part is key, they stressed: translating screening information into actionable interventions will be crucial for closing gaps in digital readiness and narrowing existing disparities in digital health engagement.

Returning to Catalonia, a separate group of experts working with the Catalan Health Service took a closer look at how to operationalize community-level information on digital readiness into broader improvements in care.  

After conducting participatory design exercises with 265 people, including patients, caregivers, clinicians, and healthcare leaders, they found that individual-level and community factors were only part of the challenge.  Unsurprisingly, health system processes and dynamics also played a significant role in lower digital engagement.

Addressing system fragmentation, developing digital tools that account for the needs of higher-risk populations, and improving infrastructure must all play a role in raising overall levels of digital readiness, the participants stressed.

Perhaps most importantly, the participants urged technology leaders and policymakers to take a “needs first” approach to improving readiness. Instead of beginning with a technology solution and expecting users to adopt around it, efforts to address digital engagement should begin with patient and clinician input and develop technologies that are better suited to their challenges and opportunities.

“Traditional top-down development processes systematically exclude the voices of those most affected by health disparities, particularly vulnerable populations who experience the greatest barriers to digital health access,” the study said.

In contrast, a participant-led approach “ensures a deep understanding of user needs before developing solutions, avoiding the premature solutioning that often leads to health technology failure,” the team continued.

Treating digital readiness as a distinct SDOH could give health systems a more nuanced understanding of which patients and communities may struggle to engage, why those barriers exist, and where interventions may be most effective. By reexamining digital readiness within the framework of social determinants of health – and how to apply that knowledge to real-world interventions – healthcare leaders could make meaningful progress toward reducing digital health disparities and increasing capacity for individuals and communities to make the most of what digital tools can offer.

Jennifer Bresnick is a journalist and freelance content creator with a decade of experience in the health IT industry.  Her work has focused on leveraging innovative technology tools to create value, improve health equity, and achieve the promises of the learning health system.  She can be reached at [email protected].